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Response To the Right Intervention (RTRI): Marrying Neurocognitive Science to RTI

In an excellent chapter, “Linking School Neuropsychological with Response to Intervention Models,” in Best Practices in School Psychology, Della Toffalo (2010) asserts that “…educationally relevant cognitive neuropsychological assessment…can and should occur at any time (any tier) in the RTI process when an intervention team has good reason to believe that standard protocol interventions may not be adequate to address the needs of an at-risk student (p.176).”

What does this mean? When IDEA was revised to include RTI as a way to establish eligibility for special education to correct the flaws of the ability discrepancy approach, it did not go far enough. That is, students who simply fail to be successful after a RTI plan should not be automatically considered to be learning disabled. First, this view of a learning disorder fails to include the universally accepted definition of a learning disability as including a processing deficit. Moreover, it just becomes another wait-to-fail model as students may proceed through tiers of intervention without the process being informed by cognitive processing information that could help in targeting students’ deficits earlier in the intervention process.

To elaborate, it is essential that the intervention team have available all tools that can diagnose students’ learning, behavioral, or emotional difficulties at any time (any tier). Della Toffalo includes a list of disorders involving learning disabilities which RTI alone may not be successful. It just makes no sense not to use all the neuropsychological tools available to identify the source of students’ learning and performance difficulties and to have this information drive the intervention process. Otherwise, the team is in danger of shooting from the hip, a practice that may inevitably lead to the failure of the prescribed interventions.

For example, academic subjects are byproducts of cognitive processing skills. Identifying and isolating those processes that are causing students’ problems can lead to more effective interventions. Does a students’ reading problem stem from a phonological or orthographic processing deficit? Are math problems due to a problem with memorizing basic math operations or the sequential steps to solve a word problem or to conceptual difficulties? This kind of specific knowledge about students’ issues is needed to craft an individually tailored plan. This kind of information can be obtained from the administration of specific subtests from a neuropsychological battery that are targeted to the areas of concern. In addition, this can all be done prior to going through four tiers when a full battery is needed. Of course, if a comprehensive evaluation is needed, it should be considered. However, RTRI can spare students and the intervention team a lot of time, effort, and pain.

Emotional Attunement in Teaching and Therapy: Some Things Do Not Change

As the fields of education and psychotherapy continue to evolve toward an increasing reliance on “evidence based practices,” it is of equal or even greater importance not to forget that the preponderance of the professional literature points to the importance of emotional attunement in teaching or in whatever form of therapy is being practiced. In our fast paced world, it may be easy to assign a lesser value to certain relationship variables that are prerequisites for making therapy work. Having a good enough relationship with students and patients provides the leverage that moves them to engage collaboratively on the road to accomplishing their goals.

Creating a relationship that will support teaching or therapy in good times and bad begins with a recognition of the immense power of induced emotion. That is, emotions are constantly being exchanged between therapists and teachers and their patients and students often nonverbally and without being noticed unless one is primed to recognize them. Just as we unknwoleingly catch colds, we also catch emotions. Strong emotions, positive or negative, need to be experienced, tolerated, and washed clean of any toxic elements that may derail the therapeutic or educational process. In a previous paper, I cited a quote from Sheldon Kopp who referenced a biblical saying: “If you want to raise a man from mud and filth, do not think it is enough to keep standing on top and reaching down to him a helping hand. You must go all the way down yourself, down into the mud and filth. You must not hesitate to get yourself dirty.” This is not an easy task. It means using the emotions being communicated in a personal way without personalizing them. When all feelings are tolerated and can be mirrored, then patients and students feel they are with someone who is like them. As a result, they are more likely to like you, and this makes the teaching or therapy “go.” Resisting the urge to take actions to deflect emotions that feel intolerable must be resisted because this amounts to rejecting the student or patient.

It is only through this process of embracing the emotional contagion that is part and parcel of every human relationship that we can return to those with whom we are engaged in an educational or therapeutic process an emotional communication that will move students or patients progressively forward.

 

Summer is Almost Here: A Perfect Time for a Neuropsychological Evaluation

If your student has had a difficult year, summer is the time to consider an evaluation to understand the roots of the difficulties and to develop a plan to address them in the fall in order to have a better next year.

Why a neuropsychological evaluation?

A neuropsychological evaluation is the most comprehensive assessment available. The scope of the evaluation is much broader than psycho-educational evaluations performed at school. Moreover, the choice of a test battery and the interpretation of the findings rely on a theoretical framework that represents the best science available.

What does a neuropsychological evaluation assess?

Academic subjects are comprised of neuropsychological processes including cognitive processing abilities and executive functions. The neuropsychological evaluation assesses these brain processes with a focus on understanding which of these is the cause of the academic or behavioral problem.

What kind of help can I expect to get from a neuropsychological evaluation?

The evaluation will examine each of the processing abilities and executive functions involved in performing successfully in each academic area. Once that information is obtained, an individualized instructional plan can be created that is tailored to each student’s neuropsychological profile. This will help teachers to differentiate instruction in a way that targets specific areas of deficit.

Why should I seek an evaluation from me?

First, I conduct all evaluations personally. I do not use a technician to perform the testing. This is important because the observations and interactions that occur during the test administration are very important parts of understanding your student. I believe the testing and the interpretation should be done by the same person. In addition, the reports I write are done personally after extensive analysis of the data and are not computer generated with reams of general and impractical recommendations.

Second, I have been conducting evaluations and working with children and adolescents for over 35 years. I know child and development and I know how to create a test battery that focuses on your student’s issues. My knowledge of the linkages between processing skills and academic performance and how to make realistic, practical, and reasonable recommendations has been obtained over three decades.

Third, I have intimate knowledge of how schools work and understand what kinds of recommendations they are able to implement and those they would ignore.

Fourth, I remain available after the evaluation to help you navigate the school system and child study team. I can accompany you to school meetings and help you in advocating for your student.

The Importance of Understanding before Doing: Fixing Response to Intervention (RTI)

Anyone who reads the RTI literature will see the word “fidelity” in the context of implementing interventions. This is, of course, common sense in that any interventions need to be applied properly. However, in order to attain fidelity, the teachers (and planners) need to have an understanding of why a strategy is being recommended otherwise it is in danger of being applied in a robotic, out of context fashion without any real conviction by the teacher. Having a belief in what is being done can only be accomplished by first comprehending the purpose of the strategy, having an opportunity to ask questions about it and even share objections or reservations about it, and discussing what to do in the event it fails to deliver the expected result.

It has been my experience that teachers often have not been given a framework from which to observe, analyze, and understand student’s difficulties. They are then in the position of doing what they know and if this does not work, they reach an impasse about what to do next. Adopting the principle of understanding before doing is the first step in changing this situation and providing teachers with the supports and tools they need to feel success with their struggling students.

What do they need to understand? Academic and behavioral challenges are best understood through the lens of the framework the Cattell-Horn-Carroll cognitive processing theory provides. First, teachers need to know that academic subjects are really byproducts of neuropsychological processes like cognitive processing abilities and executive functions. Second, by understanding the linkages between cognitive processing and academic subjects, teachers can better identify the specific processing domains that are causing a student’s struggles. At the very least, they can begin to generate informed hypotheses about the root causes which can then be translated in interventions tailored to the individual student’s cognitive profile.

Providing the “toolbox” or evidenced based strategies is the easy part. Training teachers to understand students’ difficulties and to create an instructional approach that emanates from this understanding is the key to fixing RTI. That is, we need to stop shooting from the hip or applying general strategies top individual students. This is one of the reasons RTI may not work. Moreover, having a framework to understand academic and behavioral challenges allows teachers to have an idea of what to do next if a strategy fails. It is important not lose faith if this occurs because each failure yields important information about what to do next.

However, it is essential to understand before doing. Students are complex and teaching is equally complex. Being able to break down academic tasks into the prerequisite processing skills needed will provide teachers with a concrete way to identify, understand, and “fix” their students’ challenges. Without it, RTI can be an exercise of whistling in the wind.

Peeling Back the Onion: The Value of a Neuropsychological Approach to Assessment

Neuropsychological assessment has historically been the province of evaluating individuals with some kind of brain trauma. However, in recent decades, the value of understanding cognitive processing skills and executive functions and their links to instructional practices for students has been acknowledged. In fact, academic subjects are considered to be byproducts of groups of cognitive processes that are necessary to learn and perform successfully in each subject area such that there is an arbitrary dividing line between the subjects and the brain processes themselves. In essence, the cognitive processes are the subjects.

A comprehensive evaluation of these processes implicated in learning and learning disorders includes assessing seven broad abilities and many more narrow abilities that are part and parcel of each skill area. It is essential to understand the part the different narrow abilities play in each ability domain in order to avoid making incorrect assumptions about students’ strengths and weaknesses. For example, an important broad ability, crystallized intelligence, measured by the WISC-V and required in reading, solving math problems, and generating narrative writing, is comprised of tasks that involve both the retrieval from long term memory of already acquired word definitions and identifying commonalities between dissimilar objects or ideas (i.e. concept formation). While each is part of this broad ability, each is also a very different skill. Consequently, if students score well when retrieving word definitions, but perform much less well in forming abstract concepts, then the overall broad ability score must be interpreted in this context. That is, if the overall ability score is Average because the scores on each task are combined, this does not necessarily mean that the student has Average crystallized intelligence. It may mean that a student has good rote recall, but weak abstract reasoning. Combining the scores masks the deficit. Peeling back the onion by differentiating between concept formation, an abstract reasoning skill, and long term recall, gives teachers and parents a roadmap about how to address students’ weaknesses by tailoring the approach to each student’s learning profile of cognitive processing strengths and weaknesses.

It is of equal importance not to omit assessment of any one of the broad ability areas. For example, many students who have difficulty reading suffer from dysphonetic dyslexia, a disorder of phonemic awareness where they are unable to decode or make connections between letters and sounds. Yet, there are some students whose decoding is not the issue. They may experience orthographic or surface dyslexia where they are unable to visually recognize the shapes and contours of letters and sounds or retrieve them from long term memory. Remember, reading begins visually although encoding happens phonetically. Students with undiagnosed surface dyslexia may unknowingly be prescribed a reading approach to correct a decoding problem rather than the difficulty with orthographic processing, resulting in rising frustration.

A competent neuropsychological evaluation will ferret out the subtleties that lie in the various narrow abilities that comprise each broad ability area. Most importantly, once the pattern of strengths and weaknesses is known, interventions can be targeted at the areas of deficit and utilize the areas of strengths to compensate. For professional evaluators, teachers, and parents, it is essential to understand before you do. Peeling back the onion may mean conducting either additional or targeted assessments to the areas suspected of being at the root of a learning problem. This kind of assessment approach, called cross battery assessment, is also individualized as it follows the principle of one size does not fit all. Peeling back the onion involves testing in the suspected area until you understand where the obstacles exist. Stopping the assessment prematurely may result in missing important information or clouding the interpretation of testing results.

Let’s Make NJMTSS a Success

86713_5_80x100Coming in January, 2018, the state DOE will be pushing out its’ Multi-Tiered Support System (NJMTSS) initiative to bolster efforts to support ALL students.

It will be essential to infuse MTSS with a theoretical framework that will provide teachers, child study teams, and administrators with a way to understand how students learn and what obstacles block their learning and performance. The Cattell-Horn-Carroll (CHC) principles are our best science about the kinds of cognitive processing skills that are necessary to read, write, and do math. CHC posits that academic subjects are byproducts of these cognitive processing skills. When paired with the Pattern of Srengths and Weaknesses (PSW) method of assessing students’ cognitive processing and executive functioning profiles, a roadmap can be created to tailor a specific plan to address weaknesses and highlight strengths. Teachers, in particular, need a way to understand why students are having trouble reading, solving math problems, and generating narrative writing. CHC and PSW provides a way to create individualized educational plans tailored to each student’s needs.

I, along with members of for professional groups in NJ-the NJ Psychological Association, the NJ Association of School Psychologists, the NJ Association of Learning Consultants, and the Learning Disabikuty Association of NJ-have been working hard to spread the word by sharing what we know. We are training child study team members, teachers, and interested administrators. If you have an interest in learning more about CHC and PSW and how it can help your school team or increase your knowledge base, feel free to contact me.

let’s get a jump start on making NJMTSS a success to support all of our students.

Academic Anxiety and Keeping Kids Safe at School

Feeling safe at school involves much more than providing a physically safe environment. Kids need to feel safe academically as well. Over the last decades, increased academic demands-particularly those that do not take into consideration the basic facts about child development-result in placing pressure on students to perform tasks that they are not yet ready to do. A prime example of this is the pressure kids and parents experience regarding the need to read in kindergarten. While some children are ready to read, others require the gift of time. Yet, being unable to read or read fluently sends up red flags that propel teachers to have children sent for extra help, to be evaluated, and, even more significantly, to reflect back to kids either verbally or nonverbally the sense of worry about them being unable to master the skill of reading. While some children could benefit from these interventions, others simply have not acquired the requisite cognitive processing skills to achieve to classroom expectations. Another example of this is giving kindergarten children a multi-step directive after a read aloud that asks them to return to their seats, and write a story with a beginning, middle, and an ending! This task is way beyond most students this age and developmental level.

When kids feel unable to achieve mastery, they do not feel safe. School becomes a place where they feel worried and feel less than the peers who have been able to do things that they are not yet able to do. Pressures placed on teachers to have their students score well on standardized tests add to the sense of worry and pressure as they, too, do not feel safe with regard to their own evaluation as educators. For kids, school is their job. Adults know what it is like to report to a job each day that they do not like or one in which they feel they are underachieving. This is the same kind of feeling induced in kids. Worrying about being unable to do the homework or complete a worksheet in class induces in children a feeling of vulnerability.

Many years ago, Dr. David Elkind, a Harvard psychologist, wrote a book entitled, “The Hurried Child,” warning of the dangers of exposing children to stimulation that they are not yet able to developmentally digest. Just like giving an infant solid food before they are ready, students who are pressured to perform tasks that they are not yet ready to do will “spit” it back at us in the form of a wide range of behaviors, including withdrawal, oppositional behavior, anxiety, or even school refusal. Feeling afraid to say or do something at school because the stimulation in the form of academic pressure for mastery is developmentally overwhelming turns kids off to school and learning, worries parents and teachers, and can lead to any one of a number of non-constructive consequences. Self-esteem dips and worry can morph into sadness or depression. The kind of excitement and curiosity school is supposed to foster in students gets lost in the dust of the push for achievement no matter the cost.

This situation leads to schools producing learning and behavioral problems in school instead of a sense of safety and enthusiasm for learning. Add to this exposure to environmental stimulation in the media (i.e. see the classic study from the American Psychological Association about the effect of viewing TV violence on children) and technology that brings all kinds of overstimulating material directly into our homes and schools, and it is easy to understand how young children are developing a sense of worry at greater rates than we have seen before.

As adults, our primary job is to monitor and filter the stimulation to which our children are exposed in order to keep them safe. Technology and the well-meaning push for academic achievement have added to the burden of fulfilling this task. Nevertheless, it is adult’s prime directive when it comes to the children in our care.